| NPI | 1154858736 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | KRISTINE MARIE MARTINO Executive Director 307-514-0510 |
| Organization Subpart ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family |
| Enumeration Date | 2017-05-15 |
| Last Update Date | 2024-02-12 |